Role of self-expanding metal stents in the management ofvariceal haemorrhage： Hype or hope？

• 作者: Beirne Brian J Hogan, James P O rsquo
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Esophageal and gastric VARICES STENTS Liver CIRRHOSIS GASTROINTESTINAL HAEMORRHAGE Portalhypertension
• 年，卷（期）: 2016,（1）
• 页码范围: 23-29
• 页数: 7页
• 分类号: R

摘要

Despite the advances of medical, endoscopic andradiological therapy over recent years the mortality ratesof acute variceal haemorrhage are still 16%-20% and themedium term outcome has not improved in the last 25years. Early transjugular intrahepatic portosystemic shunthas proved to be an effective therapy for selected groupsof patients with a high risk of re-bleeding and moderateliver disease. However, there is an unmet need for atherapy that can be applied in patients with a high risk ofre-bleeding and advanced liver disease either as definitivetherapy or as a bridge to permanent therapy. Selfexpandingmetal stents can be placed without the needfor endoscopic or fluoroscopic control and, once in place,will provide effective haemostasis and allow a routefor oral fluids and nutrition. They can remain in placewhilst liver function recovers and secondary prophylaxisis initiated. We review the results of 6 case seriesincluding a total of 83 patients and the first randomisedcontrolled trial of self-expanding metal stents vs balloontamponade （BT） in the management of refractory varicealhaemorrhage. We report that self-expanding metal stentsprovide effective haemostasis and perform better thanBT in refractory bleeding, where they are associated withfewer complications. Whilst the most effective place forself-expanding metal stents in the management algorithmneeds to be determined by further randomised controlledtrials, currently they provide an effective alternative to BTin selected patients.